Dental MCQ
The mouth as a window · Oral Pathology · INBDE Patient Cases

Systemic & Oral Manifestations INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on systemic & oral manifestations. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

8 patient cases40 linked questionsADA INBDE formatFull distractor explanations

Eight ADA INBDE-format patient cases on systemic disease and its oral manifestations: leukemia presenting as gingival enlargement and spontaneous bleeding, iron deficiency anemia with atrophic glossitis and the Plummer-Vinson association, undiagnosed diabetes with refractory periodontitis and the bidirectional link, Addison disease with diffuse mucosal pigmentation, Crohn disease with cobblestone mucosa and oral ulcers, dental erosion (perimylolysis) from gastroesophageal reflux or an eating disorder, an inherited bleeding disorder before an extraction, and Behcet disease with recurrent oral and genital ulcers and uveitis. Topics include hematologic disease, nutritional and endocrine disease, gastrointestinal disease, and immune, dermatologic, and syndromic disease, with the unifying lesson that the dentist may be the first to detect systemic disease from an oral sign.

Case Coverage Map
What each case is testing
Swollen, spontaneously bleeding gums and fatigue:
Leukemia presenting orally, bleeding out of proportion to plaque, the complete blood count and referral, and deferring invasive care.
A sore, smooth tongue and cracked lip corners:
Iron deficiency anemia and atrophic glossitis, Plummer-Vinson, the B12 contrast, and referral for blood work.
Refractory gum disease and slow healing:
Undiagnosed diabetes, the bidirectional perio link, poor healing and candidiasis, and combining periodontal therapy with glycemic control.
New diffuse darkening of the mouth and skin:
Addison disease pigmentation, the ACTH mechanism, distinguishing it from a local amalgam tattoo, and medical referral.
Cobblestone cheeks and persistent mouth ulcers:
Oral Crohn disease, mucosal tags and linear ulcers, oral signs preceding the gut diagnosis, and pyostomatitis vegetans in ulcerative colitis.
Acid erosion on the back of the teeth:
Palatal/lingual erosion (perimylolysis) from reflux or an eating disorder, the location clue, and addressing the cause plus protection.
Easy bruising and a family bleeding history before an extraction:
An inherited bleeding disorder, assessing bleeding risk proactively, factor and local hemostasis planning, and platelet causes.
Recurrent mouth ulcers with eye and genital symptoms:
Behcet disease (oral plus genital ulcers and uveitis), when recurrent ulcers signal systemic disease, and the lupus contrast.
Patient case: Swollen, spontaneously bleeding gums and fatigue
0 of 5 answered, 0 correct
Patient
Male, 34 years old
Chief Complaint
"My gums are swollen, bleed on their own, and I've been exhausted and bruising easily."
Background and/or Patient History
  • Rapid onset of gingival swelling and spontaneous bleeding
  • Weeks of fatigue, pallor, and easy bruising
  • Recurrent infections lately
  • Gingival changes out of proportion to his plaque
Allergies
NKDA
Medications
  • None
Current Findings
  • Diffuse boggy gingival enlargement with spontaneous bleeding and mucosal petechiae
  • Pallor and scattered bruises
  1. Question 1
    Moderate
    Diffuse gingival enlargement and spontaneous bleeding out of proportion to plaque, with fatigue and bruising, should raise concern for:
  2. Question 2
    Moderate
    The gingival changes being out of proportion to plaque is significant because it:
  3. Question 3
    Moderate
    The most appropriate immediate step is to:
  4. Question 4
    Moderate
    Invasive dental treatment in a patient with suspected or active leukemia should be:
  5. Question 5
    Moderate
    This case illustrates that the dentist may be:

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Patient case: A sore, smooth tongue and cracked lip corners
0 of 5 answered, 0 correct
Patient
Female, 41 years old
Chief Complaint
"My tongue is smooth and sore and the corners of my mouth keep cracking."
Background and/or Patient History
  • Burning, smooth tongue and angular cheilitis for weeks
  • Fatigue and a recent sense of breathlessness on exertion
  • Heavy menstrual periods
  • No local cause for the tongue changes
Allergies
NKDA
Medications
  • None
Current Findings
  • Atrophic (smooth) tongue with loss of papillae; angular cheilitis
  • Pale appearance
  1. Question 1
    Moderate
    A smooth (atrophic) tongue with angular cheilitis, fatigue, and pallor most suggests:
  2. Question 2
    Hard
    Iron deficiency with dysphagia and an esophageal web is known as:
  3. Question 3
    Moderate
    The appropriate next step is to:
  4. Question 4
    Moderate
    A beefy-red, smooth tongue, by contrast, would more specifically point to:
  5. Question 5
    Moderate
    The general principle is that a smooth, sore tongue should prompt:

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Patient case: Refractory gum disease and slow healing
0 of 5 answered, 0 correct
Patient
Male, 52 years old
Chief Complaint
"My gums keep getting infected, things heal slowly, and I get mouth yeast."
Background and/or Patient History
  • Periodontitis that responds poorly to treatment
  • Recurrent oral candidiasis and slow healing after procedures
  • Increased thirst, frequent urination, and recent weight loss
  • No prior diagnosis of diabetes
Allergies
NKDA
Medications
  • None
Current Findings
  • Generalized periodontitis worse than expected for local factors
  • Oral candidiasis; delayed healing
  1. Question 1
    Moderate
    Refractory periodontitis, recurrent candidiasis, and poor healing with thirst and weight loss suggest undiagnosed:
  2. Question 2
    Moderate
    The relationship between diabetes and periodontitis is:
  3. Question 3
    Moderate
    The appropriate step regarding the systemic finding is to:
  4. Question 4
    Moderate
    Why does uncontrolled diabetes worsen oral health?
  5. Question 5
    Moderate
    Optimal management of his periodontitis includes:

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Patient case: New diffuse darkening of the mouth and skin
0 of 5 answered, 0 correct
Patient
Female, 39 years old
Chief Complaint
"The inside of my mouth and my skin have darkened, and I feel weak and tired."
Background and/or Patient History
  • New diffuse brown pigmentation of the oral mucosa and skin
  • Fatigue, weakness, and lightheadedness on standing
  • Salt craving and weight loss
  • No amalgam restorations near the pigmented areas
Allergies
NKDA
Medications
  • None
Current Findings
  • Diffuse, patchy brown mucosal pigmentation (buccal mucosa, gingiva)
  • Generalized skin hyperpigmentation; low blood pressure
  1. Question 1
    Moderate
    Diffuse mucosal and skin hyperpigmentation with fatigue, weakness, and low blood pressure suggests:
  2. Question 2
    Hard
    The pigmentation in Addison disease is driven by:
  3. Question 3
    Moderate
    A feature that distinguishes this from a benign amalgam tattoo is that the pigmentation is:
  4. Question 4
    Moderate
    The appropriate action is to:
  5. Question 5
    Moderate
    This case reinforces that diffuse oral pigmentation should prompt consideration of:

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Patient case: Cobblestone cheeks and persistent mouth ulcers
0 of 5 answered, 0 correct
Patient
Male, 28 years old
Chief Complaint
"The inside of my cheeks look bumpy and I keep getting mouth ulcers."
Background and/or Patient History
  • Cobblestone appearance of the buccal mucosa with mucosal tags
  • Recurrent oral ulcers and linear ulcers in the vestibule
  • Abdominal pain, diarrhea, and weight loss
  • No local cause for the oral findings
Allergies
NKDA
Medications
  • None
Current Findings
  • Cobblestone buccal mucosa, mucosal tags, and linear vestibular ulcers
  • Generally unwell with reported gastrointestinal symptoms
  1. Question 1
    Moderate
    Cobblestone buccal mucosa, mucosal tags, and linear ulcers with gastrointestinal symptoms suggest:
  2. Question 2
    Moderate
    Oral manifestations of Crohn disease may:
  3. Question 3
    Moderate
    The appropriate step is to:
  4. Question 4
    Hard
    Another inflammatory bowel disease, ulcerative colitis, can be associated with which oral lesion?
  5. Question 5
    Moderate
    The general lesson is that distinctive mucosal patterns can be a clue to:

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Patient case: Acid erosion on the back of the teeth
0 of 5 answered, 0 correct
Patient
Female, 26 years old
Chief Complaint
"The backs of my upper teeth are wearing away and sensitive."
Background and/or Patient History
  • Erosion concentrated on the palatal surfaces of the upper teeth
  • Reports heartburn and an acid taste, especially at night
  • Increasing tooth sensitivity
  • No high-acid diet reported
Allergies
NKDA
Medications
  • None
Current Findings
  • Smooth enamel loss on the palatal and lingual surfaces (perimylolysis)
  • Otherwise healthy dentition
  1. Question 1
    Moderate
    Erosion concentrated on the palatal and lingual surfaces points to:
  2. Question 2
    Moderate
    Given her heartburn and nocturnal acid taste, a likely cause is:
  3. Question 3
    Hard
    If reflux is not present, another important cause of this erosion pattern to consider sensitively is:
  4. Question 4
    Moderate
    Appropriate management includes:
  5. Question 5
    Moderate
    This case reinforces that the location of dental erosion can:

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Patient case: Easy bruising and a family bleeding history before an extraction
0 of 5 answered, 0 correct
Patient
Male, 30 years old
Chief Complaint
"I need a tooth out, but I bruise easily and bleed a long time when cut."
Background and/or Patient History
  • Lifelong easy bruising and prolonged bleeding from minor cuts
  • A family history of a bleeding problem
  • Needs an extraction
  • Not on any anticoagulant medication
Allergies
NKDA
Medications
  • None
Current Findings
  • Scattered bruises; otherwise well
  • A non-restorable tooth requiring extraction
  1. Question 1
    Moderate
    Lifelong easy bruising and prolonged bleeding with a family history suggest:
  2. Question 2
    Moderate
    Before the extraction, the most appropriate step is to:
  3. Question 3
    Moderate
    For a patient with a significant inherited bleeding disorder, surgery may require:
  4. Question 4
    Moderate
    Petechiae and ecchymoses on examination can also reflect:
  5. Question 5
    Moderate
    The key principle is that a bleeding history before oral surgery should be:

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Patient case: Recurrent mouth ulcers with eye and genital symptoms
0 of 5 answered, 0 correct
Patient
Male, 31 years old
Chief Complaint
"I get severe mouth ulcers over and over, and now genital ulcers and red eyes."
Background and/or Patient History
  • Frequent, severe recurrent oral ulcers beyond typical canker sores
  • Recurrent genital ulcers
  • Episodes of painful red eyes (uveitis)
  • Occasional joint pains and skin lesions
Allergies
NKDA
Medications
  • None
Current Findings
  • Multiple painful oral ulcers, recurrent and severe
  • History consistent with multisystem involvement
  1. Question 1
    Moderate
    Recurrent severe oral ulcers with genital ulcers and uveitis are characteristic of:
  2. Question 2
    Moderate
    The most common clinical feature of Behcet disease is:
  3. Question 3
    Moderate
    These findings together should prompt the dentist to:
  4. Question 4
    Moderate
    Recurrent oral ulcers that are unusually severe, frequent, or begin in adulthood should generally prompt:
  5. Question 5
    Moderate
    Another systemic autoimmune disease that can cause oral ulcers, with a classic malar rash, is:

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Systemic & Oral Manifestations core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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